Anthem counters city criticism over insurance payments

LACONIA — Anthem Blue Cross Blue Shield officials say the insurance company has been diligently processing payments for city ambulance services, even though City Manager Scott Myers contends they owe the city $55,000.

The difference of opinion may rest in part on where the money is being sent.

In some cases, people who have used the ambulance service have received payments directly from Anthem but have not forwarded the money to the city.

Stephanie DuBois, a spokeswoman for Anthem, said Thursday that in such cases it’s up to the city to collect from these people.

“We have processed all claims in this matter in a timely manner and in accordance with state regulations and contract requirements,” she said.

Insurance companies often have agreements, or contracts, with ambulance services and other medical providers that specify how much should be paid for services. This reduces insurance costs and payments are sent directly to providers.

However, DuBois said the Laconia Fire Department has declined to enter into such an agreement with Anthem, one of the state’s largest insurance providers.

Myers wasn’t clear when asked whether the city has any such agreements.

“The City has a number of professional relationships through our EMS service and billing that we are in communication with,” he said. “Ultimately, my loyalty and responsibility is to do the best that I can on behalf of the Mayor/City Council and the taxpayers of Laconia.”

He said the city is “monitoring and learning some of the trends on how different payers handle their EMS bills from the City.”

Even without an agreement, Anthem says it sends payments directly to the city in cases where the consumer holds an Anthem New Hampshire policy, but it contends that if the consumer holds an out-of-state Anthem policy, the company is legally permitted to send payment directly to the consumer.

“For consumers covered by self-insured or out-of-state plans who receive services from ambulance providers that do not participate in our network, reimbursements are made directly to the consumer,” she said via email. “It is the responsibility and right of the provider of services to bill and collect from those consumers who received reimbursement directly from their insurer.”

Myers said state statute requires that such insurance checks should be payable to the insured person and the medical provider or ambulance service.

DuBois said New Hampshire statutes only apply to New Hampshire insurers and do not apply to an out-of-state insurer, such as Anthem’s divisions in Maine, Connecticut or other states.

For example, if an Anthem policy holder from Maine had a summer home in Laconia and needed an ambulance ride, payment for that service would be sent directly to the policy holder.

LRGHealthcare ended its support for municipal ambulance services on June 30. After that, the city took over billing duties.

So far, the city has never had a month when it collected payments covering more than 62 percent of net charges from ambulance runs. The balance due from July through January is $386,909.

Myers said he thinks the payment rate will come up to 70 percent, which would cover the city’s $1 million budget for these services.

Last year, the city had the chance to turn the ambulance system over to a private company, Brewster Ambulance, which would have handled calls and billed for services, all at no cost to the city. The company backed out after Laconia firefighters said they didn’t want to lose responsibility for running the ambulance service and were afraid some firefighters could be laid off.

Ambulance runs, which average about 300 a month, make up the overwhelming majority of the fire department’s emergency calls.

Through seven months of the fiscal year, the city has collected $417,244 in payments, which often arrive months after the services were provided.